Provider Demographics
NPI:1467151191
Name:DANIEL AND WENDY NATHAN
Entity Type:Organization
Organization Name:DANIEL AND WENDY NATHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:419-377-3057
Mailing Address - Street 1:2114 AUDUBON PL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3301
Mailing Address - Country:US
Mailing Address - Phone:419-377-3057
Mailing Address - Fax:
Practice Address - Street 1:3454 OAK ALLEY CT STE 400
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1355
Practice Address - Country:US
Practice Address - Phone:419-377-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0406817Medicaid
OH0287657Medicaid